link between rheumatoid arthritis and periodontal disease

Gum disease has become a widespread dental issue worldwide. Several factors contribute to the initiation of gum disease. You might be surprised to hear that despite oral factors, many autoimmune disorders also affect the gums. One among such disorders is Rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joints. This disorder causes pain and disability of the joint to function correctly.

Additionally, rheumatoid arthritis can also affect the internal organs and damage the health of oral tissues. Recent studies have revealed a significant increase in gum disease and periodontal disease-causing bacteria in individuals with rheumatoid arthritis. Antibody response to citrullinated proteins characterizes autoimmunity in rheumatoid arthritis. In our mouth, porphyromonas gingivalis is the only known bacteria that express an enzyme to generate citrullinated proteins.

Such antibody reactions increase the functions of porphyrins gingivalis and increase the risk of gum disease and periodontal breakdown. Let’s continue to read the article to understand the relationship between rheumatoid arthritis and gum disease.

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic more autoimmune disease which mainly affects the joints in the body. Most of the times, it involves the wrist and hand joints. However, rheumatoid arthritis may also affect some of the internal organs and oral tissues. (1) Typical symptoms of rheumatoid arthritis include swollen joints, pain and stiffness and inflammation around the affected area.

What do you mean by gum disease?

Gum disease, as the name suggests, is an infection of the gingival tissues. The primary sites that get affected by gum infection are the crevices between the teeth and area under the gumline. Progression of gum disease often involves the periodontal tissue and causes detachment of the gums from the tooth surface. As the tissues continue to deteriorate, it forms deep pockets filled with food debris and infection-, causing bacteria. (2) Typically gum disease is characterized into two categories –

  • Gingivitis – This is a less severe and a reversible form of periodontal disease.
  • Periodontitis – This is an advanced form of gingivitis which causes more destruction to the gums and tooth-supporting tissues.

What is the link between gum disease and rheumatoid arthritis?

The Journal of Periodontology recently issued german research, which involved 57 patients with rheumatoid arthritis. A control group of 52 healthy patients was also formed to compare the results. Each was matched with age and gender to keep the study uniform. Examination of plaque index, gingival index, probing depth, and clinical attachment loss of all the participants was performed. The study revealed that rheumatoid arthritis and age were the significant predictors of periodontal disease. (4)

It was noted that patients with rheumatoid arthritis were eight times more likely to experience the periodontal disease as compared to the healthy group of patients. Porphyromonas gingivalis is one of the disease-causing bacteria in our mouth that mainly affects the health of the gums. Clinical studies revealed that porphyromonas is the only human pathogen known to express n enzyme that generates citrullinated proteins.

Citrullination is a process wherein a protein undergoes a molecular change in structure. Interestingly, the autoimmunity in rheumatoid arthritis is characterized by an antibody response to citrulinated proteins. This study concluded a direct connection between rheumatoid arthritis and periodontal disease. (5)

A study presented at the American College of Rheumatology found that people with periodontitis tested positive for antibodies that act against citrullinated proteins. This study confirmed the association of oral bacteria with rheumatoid arthritis. There is a high plausible biological connection between rheumatoid arthritis and periodontal disease. Special dental attention should be paid on people with rheumatoid arthritis to maintain healthy gums.

Some of the steps you can follow to take care of your health are as follows –

  • Schedule regular dental examinations
  • Switch to a healthy and balanced diet which includes fresh fruits and vegetables
  • Brush and floss regularly. Additionally, use an antibacterial mouthwash for improved oral hygiene.
  • If you have stiff and painful hands or jaw – talk to your dentist about alternative dental care products to ease the process of tooth brushing.
  • Follow up your doctor’s appointment to keep rheumatoid arthritis under control.

It is essential to get more information about your health and oral condition. Doing so could potentially save both your teeth and joints.

What are the risk factors for gum disease?

Several factors increase the risk of developing gum disease. Some of them may include –

  • Systemic disease such as rheumatoid arthritis (3)
  • Medications like steroids or oral contraceptives
  • Improper bridge or filling
  • Crooked teeth
  • Pregnancy
  • A habit of smoking or chewing tobacco

What are the signs and symptoms of gum disease?

Initial stages of gingivitis may not show any significant signs. Therefore, regular dental check-ups are essential to evaluate the health of your gums periodically.

As the disease progresses and reaches the stage of periodontitis, you may notice some of the following signs and symptoms –

  • Bleeding gums especially after tooth brushing
  • Red and swollen gums
  • Pain and tenderness around the affected area
  • Gum recession
  • Presence of deep periodontal pockets
  • Persistent bad breath and taste alteration
  • Loose teeth
  • Change in the bite or fit of dentures

Take away message

Autoimmune disease can have a significant impact on your health and oral conditions. Rheumatoid arthritis is one among such autoimmune disease that often affects the gums and periodontal tissues. Rheumatoid arthritis is typically a chronic inflammation of the joints in the body. However, it may also affect oral health by increasing the risk of periodontal disease. Many clinical studies have proved that rheumatoid arthritis and periodontal disease have a direct biological connection.

One of the critical connections is the antibody reaction to citrullinated proteins generated by periodontal disease, causing bacteria called porphyromonas gingivalis. However, several on-going studies are trying to establish a stronger connection between the two diseases. The best way to stay healthy and maintain good oral health is to follow up dental and physician appointments regularly.

Additionally, maintain good oral health care routine to eliminate gum infection and its consequences. If you have rheumatoid arthritis, consult your dentist and keep a check on your oral health.